FIRST IN PULSE: SEBELIUS ADVISES GOVS ON LAWSUITS— The HHS Secretary is reminding governors that implementation goes on as normal in the wake of the Virginia ruling. “We are confident this ruling will eventually be overturned and that the Act will be upheld,” Sebelius writes in the letter sent Wednesday. “In the meantime we will continue to implement the Affordable Care Act.” Also in the letter, Sebelius stresses the importance of moving forward on implementation: “To prepare for the reforms that will take effect in 2014, such as the ban on discrimination based on pre-existing conditions, we strongly encourage states to continue their planning with respect to Exchanges and improvements to the Medicaid program.” The letter http://politi.co/i4WRNN

Good Friday morning. We thank you for all your nice comments regarding yesterday’s PULSE e-mail announcement.

Story Continued Below

“The Pulse don’t care when he sees the flame. He might get burned but he’s in the game.” (Hat tip: Michael Bonderer)

MULTI-STATE LAWSUIT ARGUMENTS HEARD— Judge Roger Vinson says he’ll rule “as quickly as possible” on the lawsuit against health reform brought by 20 states and the NFIB. (The read: mid- to late-January) He had a lot of questions for both parties about what would limit Congress’s power if the individual mandate is kept intact and sounded skeptical that the decision not to purchase health insurance is activity that can be regulated, which would advance the states’ case. But he seemed to agree with the federal government that states can easily leave the Medicaid program if they want to, citing public comments from several Republican governors suggesting they might do so in the wake of reform. The oral arguments bring “Lawsuit week,” as PULSE has dubbed it, to a close. The POLITICO story http://politi.co/f5kOEZ

--THE ENORMITY OF THE CASE ISN’T LOST ON VINSON— “All three branches of government … take the same oath and that is to protect and defend the Constitution of the United States,” he said at the opening of the oral arguments. “It is a very important matter that we’re dealing with.”

--HEALTH REFORM TRIVIA FOR YOUR HOLIDAY PARTIES— The judge presiding over the case is president of the American Camellia Society, a group devoted to growing and propagating the Camellias flowering plant. For real http://bit.ly/fqOw4H

--SPOTTED IN PENSACOLA— In addition to attorneys for both parties: Florida AG Bill McCollum, who originated the suit; Texas AG Greg Abbott; reps from NFIB and the AG offices of several of the other states on the suit. Representatives from advocacy groups were on hand, too, including Families USA’s Ron Pollack and Health Information Center’s James Chiong.

RATE REVIEW MOVES FORWARD— The regulation, which will include a much-anticipated definition of what counts as an “unreasonable” insurance premium increase, landed at OMB Friday, meaning HHS could release it any day now. The National Association of Insurance Commissioners moved the issue forward on Thursday, too: They approved a model rate review filing form that’s been in the works for months now. While HHS has no obligation to use the form—the statutory authority on this one falls to the federal agency, unlike the MLR regulation—the commissioners hinted they have reason to believe the feds will follow their lead. “HHS is generally comfortable with the form and will likely request additional detail,” Oregon Insurance Division Administrator Theresa Miller said at an NAIC executive committee meeting Thursday. NAIC rate review model form http://bit.ly/eFJz9q

--“FRANKLY DISAPPOINTED” WITH AHIP, BCBSA— Miller chided insurers for trying to slip in a number of last minute changes to the rate filing form, via comments dated Dec. 14. “If this amendment had been brought forward 5 months ago or even a few, [we] could have had a productive discussion,” Miller said. “At this point, I cannot support an amendment that has not been through an appropriate vetting process with stakeholders.” The AHIP/BCBSA comments http://politi.co/goKpFQ

--REMEMBER THE ALAMO? The NAIC also approved a series of model regulations on state health exchanges and the Sept. 23 consumer protection provisions. Texas was the lone state to vote against the provisions. What gives? Texas tells us they have no plans to use the NAIC language so it couldn’t vote in the provision’s favor. “While not fundamentally opposed to the NAIC language regarding federal health care reform items, the Texas Department of Insurance is unable to vote in favor of the model legislation,” the department tells PULSE. “In order to adhere to the NAIC procedures, TDI officials would be required to make efforts to have the model legislation introduced in the Texas Legislature. The department is simply taking a different approach to implementation more tailored to Texas Law.”

CHATTER FROM THE OCIIO HEALTH EXCHANGE MEETINGS— It’s taken on a sort of group therapy session feel, as over 150 regulators from 44 states convene in Washington to pour over the challenges and tight deadlines that come along with setting up a health insurance exchange. “Misery loves company I guess?” Vermont’s Rebecca Heintz tells us. “We’re all asking, how are we going to get this done? I think it’s been very positive. … [OCIIO] wants to hear what we have to say. They seem very open to anything we have to share with them about how things are going and how we move forward.”

--The meetings so far—they wrap up early this afternoon—have been more of states relaying information to OCIIO rather than feds giving guidance. “It’s really been helpful to hear everybody else seems to be in the dark a little bit and everybody else is struggling, that we’re not missing,” Aaron Sisk, a senior staff attorney with the Mississippi Insurance Department, tells us. “It’s nice to see there are 48 unique approaches to this, not one answer to the question of how to set up exchanges.” HHS blog post http://bit.ly/fWb3KL

HAPPENING TODAY: MAINE VOTES— The state’s Advisory Committee of Health System Development takes a final vote today on their recommendations for implementing health reform. The vote is mostly a formality, largely to approve some minor “wordsmithing” to the draft posted online, Trish Riley, who directs Gov. Baldacci’s Office of Health Policy, tells us. Draft proposal http://bit.ly/fFRfst

WHAT WE’RE READING:

Florida AG Bill McCollum says in a WaPo op-ed that health reform is critical “but it should not come at the expense of our citizens’ individual rights nor by jeopardizing the role of the states in our system of federalism.” http://wapo.st/hwzT0O

Virginia AG Ken Cuccinelli writes in another WaPo op-ed that it’s time for the Supreme Court to weigh in on the issue. http://wapo.st/ieWPzX

Medicaid isn’t perfect, but there aren’t better solutions out there, Jonathan Cohn writes in KHN and The New Republic. http://bit.ly/eD5gUX

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Jennifer Haberkorn is a senior health care reporter for POLITICO Pro. She’s covered the Affordable Care Act since it was being debated in Congress in 2009. Since then, she has written about the law from Capitol Hill, the federal agencies, the courts and outside the Beltway.

Before arriving at POLITICO, Haberkorn covered Congress and local business news for The Washington Times. Her work has also appeared in Health Affairs and The New Republic.

Haberkorn is a graduate of Marquette University, where she majored in journalism and served as editor of The Marquette Tribune.

About The Author

Sarah Kliff is a health care reporter for POLITICO Pro. As a writer for POLITICO, she has covered how federal regulation, Congress and lobbying affect the implementation of health care reform. She previously co-authored Pulse, a daily health policy briefing.

Prior to joining POLITICO, Kliff was a staff writer at Newsweek, where she covered issues at the intersection of health and politics. She also covered the 2008 election, traveling with Joe Biden and contributing reports to multiple Newsweek cover stories. She has also written for National Geographic, St. Louis Magazine and Humanities magazine.

Kliff attended Washington University in St. Louis, where she was editor-in-chief of the campus newspaper, Student Life. She grew up in Seattle and Toronto, cities that have left her a big fan of the Toronto Maple Leafs and coffee.